ResidentTraumaFINALhighres

225

Packaging Act of 1970 mandated childproof container caps and packag-

ing. Injury can range from mild mucosal irritation to death, depending

on the quantity and type of substance ingested.

A. Categories of Caustic Materials

Caustic materials may be classified into three different categories, as

shown below. Table 10.2 presents some examples of these categories of

caustic materials.

Table 10.2. Categories and Examples of Caustic Materials

Acids (pH < 7)

Alkali (pH > 7)

Bleach (pH ~7)

Toilet bowl cleaner

Battery fluid

Sulfuric acid

Lime

Laundry detergent

Clinitest

tablets

Hair-relaxing agents*

Sodium hypochlorite

Calcium hypochlorite

*Hair-relaxing agent packaging is not mandated by the U.S. Food and Drug

Administration to be sold in child-safe packaging. Their pleasant odor and colorful tubs

unintentionally attract children, leading to an increased incidence of ingestion over the

last decade.

1. Acids (pH <7)

Acids (pH <7) cause coagulation necrosis with eschar formation, which

limits its penetration to deeper tissues. Esophageal damage is less likely

due to the protection afforded by the slightly alkaline pH of the esopha-

gus and resistance of the squamous epithelium to acids. Gastric injury

may occur at a slightly higher incidence due to pooling and prolonged

contact from reflex pylorospasm. The acidic pH in the stomach can also

heighten the injury.

2. Alkali (pH >7)

Alkali (pH >7) agents cause liquefaction necrosis, which breaks down

the cellular membranes, allowing deeper penetration into tissues.

Tissue damage continues until the alkali is neutralized by its reaction

with the tissues, resulting in significant injury. Areas of narrowing are at

greater risk for injury (e.g., cricopharyngeus, aortic arch, left mainstem

bronchus, diaphragmatic hiatus).

3. Bleach (pH ~7)

Bleach (pH ~7) is an esophageal irritant that causes minimal morbidity

or mortality.